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Thurston County Emergency Medical Services System Study

Thurston County Emergency Medical Services System Study. A Report prepared for the Thurston County Emergency Medical Services Council. The Report Contents. Findings.

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Thurston County Emergency Medical Services System Study

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  1. Thurston County Emergency Medical Services System Study A Report prepared for the Thurston County Emergency Medical Services Council

  2. The Report Contents Findings Recommendationsare numbered, shownin boldfollowing the related observation. Included in strengths and challenges where appropriate.

  3. FINDINGS: • Funding • EMS System Delivery Model • System Performance • Governance • Planning Observations and Recommendations

  4. 1.1 Observation: TC Medic One operates the region’s public EMS system with a single permanent countywide EMS property tax levy that finances the vast majority of its services and functions. Funding Strengths

  5. 1.2 Observation: Nearly 90 percent of TC Medic One’s budget is programmed for operations, training, EMS support and public education. Less than 5 percent is used for administration, and the remaining is for equipment repair and replacement. 10.5% 5.6% Funding Strengths

  6. 1.3 Observation: TC Medic One expanded countywide EMS levels of service through the region’s worst economic recession since the program was created. Funding Strengths

  7. 1.4 Observation: The ALS contract agencies provide a 20 percent match for ALS personnel costs when operating within their jurisdiction. Recommendation 1.4.1 TC Medic One staff and the ALS contract agencies should closely monitor system costs, maintain a dialog, and develop a long-term strategy to manage EMS provider personnel costs. Funding Strengths

  8. 1.5 Observation:The TC Medic One System does not rely on user fees for system operation. Patients are not charged for ALS transport services. Funding Strengths

  9. 1.6 Observation:TC Medic One provides a fair and equitable distribution of EMS levy revenues and support services to all fire service agencies in the county based on service demand. In 2012: BLS Direct Support, $880,529 Training Support, $472,563 Indirect Support, $721,442 Total: $2,084,534 Funding Strengths

  10. 1.7 Observation: Expenditures are exceeding revenues.As of 2011, the County EMS Levy rate is insufficient to generate the revenue necessary to fund TC Medic One’s projected expenditures. Recommendation 1.7.1 To help meet rising expenditures, a levy lid lift campaign to restore the original levy rate should be pursued before 2017. “…the state’s imposition of a 1 percent annual property tax increase limit (RCW 84.52.050) stymies the levy’s capacity, without voter approval, to keep pace with the program’s expenditures.” TRPC Report Funding Challenges

  11. 1.8 Observation:It does not appear that a voter approved levy lid lift (restoration of $0.50/$1000 assessed value) by itself would produce sufficient revenue to eliminate the growing deficit between revenue and 2013-2017 projected expenditures. Recommendation 1.8.1 The EMS Council must identify additional revenue to sustain existing service levels or prioritize which program expenditures to maintain or cut to balance the budget with existingrevenues. Funding Challenges

  12. Actual (2003-2012) and Projected (2013-2017) EMS Levy and TC Medic One Expense Budget

  13. 1.9 Observation:TC Medic One lacks a clear budget policy on the establishment, maintenance, funding level, and use of a reserve account for contingency operations and expenditures. Recommendation 1.9.1 The EMS Council should consider establishing a long-term contingency reserve account. “Thurston County is a safe place, but it is not immune to the catastrophic effects of natural disasters, mass casualty incidents, or catastrophes that may arise in or around Thurston County.” TRPC Report Funding Challenges

  14. 1.10 Observation: Fire Protection District operations are challenged by diminishing revenues. The risk of EMS service degradation in rural communities could threaten the efficacy of the TC Medic One program. Recommendation 1.10.1 The region’s EMS participants should develop a countywide framework for evaluating present and future BLS demand and service capacity to better understand the overall financial and operational impacts to the EMS system. “The success of the ALS system rests on the capacity of BLS services.” TRPC Report Funding Challenges

  15. Summary of Fire District Levy Revenues, 2012 to 2013

  16. 1.11 Observation:There is disagreement among stakeholders about the flexibility of the EMS levy to serve TC Medic One and multiple taxing districts. Recommendations 1.11.1 The EMS Council should establish clear funding priorities for TC Medic One programs. 1.11.2 Should state legislation ever increase the levy rate limit, the EMS Council, TC Medic One staff, and the fire service agencies should convene discussions on negotiating a potential levy-sharing strategy. Funding Challenges

  17. 2.1 Observation: TC Medic One is a regional centralized EMS program that delivers a standardized high level of emergency medical care to anyone, anywhere, at any time throughout Thurston County. “In Washington State, if you have seen one EMS system, you’ve seen one.” - Michael Lopez, EMS Section Supervisor, Washington State Department of Health EMS System Delivery Model Strengths

  18. 2.2 Observation:System wide, TC Medic One ALS units are staffed with two paramedics. This configuration arguably provides a superior level of medical care at the unit level and an overall increase in countywide ALS system readiness. Recommendation 2.2.1 TC Medic One should continue exploring and testing a supplemental EMS unit configuration as an intermediate to the standard two-paramedic unit. For example, enabling Advanced EMTs to serve the system in more rural fire districts could improve patient outcomes in areas with longer ALS response time intervals. EMS System Delivery Model Strengths

  19. Simplified Cost Comparison between aTwo Medic vs. a One Medic plus EMT ALS Unit Configuration

  20. 2.3 Observation:Every community in the region stands to benefit from being part of the TC Medic One system. EMS System Delivery Model Strengths

  21. 2.4 Observation:TC Medic One staff provides a comprehensive range of administrative and support service functions that strengthen EMS service delivery. EMS System Delivery Model Strengths

  22. 2.5 Observation:TC Medic One’s provision of initial BLS training, continuing education, in-service paramedic training, and EMS quality assurance activities establish a high standard of first responder EMS care throughout the system that improves patient outcomes. EMS System Delivery Model Strengths

  23. 2.6 Observation:The nature of ALS services delivery through contract agencies creates discontent and mistrust among some of the system’s stakeholders. Recommendation 2.6.1 TC Medic One system stakeholders should visit the office of King County Medic One to learn about their system. A series of similar site visits to other neighboring EMS systems could offer local participants with valuable insight as to how Thurston County could improve its system. EMS System Delivery Model Challenges

  24. 3.1 Observation: When people dial 9-1-1 for help, the EMS system responds: it saves lives and assists and transports people who are seriously sick or injured. Recommendation 3.1.1 Beyond the traditional benchmarking focus on cardiac arrest survival rates and response time interval performance, TC Medic One staff in consultation with the Medical Program Director, should continue considering, evaluating, and implementing other appropriate metrics to measure the system’s prehospital emergency medical and trauma care across the entire county. System Performance Strengths

  25. 3.2 Observation: Three agencies provide ALS service countywide, regardless of what jurisdiction a call comes from.Any upgrade to an existing medic unit or the formation of a new unit, regardless of its principal duty location, is an upgrade to the entire county’s EMS system. 2012 Daily ALS Unit Response Volumes and Statistics System Performance Strengths

  26. 3.3 Observation:The system currently has ample response capacity to fulfill ALS service demands for the next several years. 2012 Daily ALS Unit Response Volumes and Statistics System Performance Strengths

  27. 3.4 Observation: ALS response time intervals are well within the State’s and TC Medic One’s adopted level of service goals countywide. Recommendation 3.4.1 TC County Medic One has valuable response time data that should be presented, when appropriate, in a format that is accessible and readily understood by a broader audience. System Performance Strengths

  28. Thurston County Mean ALS Response Time Intervals by Fire Service Agency Jurisdictions, 2009-2012

  29. 3.5 Observation:More work is necessary to standardize the capture, retrieval, and dissemination of EMS data throughout the system, particularly for BLS response activity data. Recommendations 3.5.1 TC Medic One should take a lead role to foster greater EMS data interoperability and information exchange. 3.5.2 TC Medic One should coordinate with fire service agencies to develop an agreed upon comprehensive EMS service demand projection for system planning. System Performance Challenges

  30. 4.1 Observation: Policy makers, staff, and stakeholders care about the system. “The roles and responsibilities for each participant should be organized in a manner that ensures that every component of the system contributes to the effectiveness of the system as a whole, without conflicts in roles and responsibilities.” NFPA 450: Guide for Emergency Medical Services and Systems Governance Strengths

  31. 4.1 Observation:EMS Council members have expressed feelings of mistrust, frustration, and dissatisfaction over recent decision making processes of the TC Medic One system. Recommendation 4.1.1 The EMS Council should identify deliberate activities to foster trust among members, learn each other’s strengths, and celebrate the Council’s successes. “With so many participants, it can be very challenging at times for EMS stakeholders in the Thurston County region to reach consensus on key decisions.” TRPC Report Governance Challenges

  32. 4.2 Observation:Rural stakeholders have expressed frustration that the composition of the EMS Council is biased toward the urban communities. • Recommendation • 4.2.1 The EMS Council should review Article IV. Composition and Membership of the Bylaws to consider amending the membership to: • 1. Include the City of Lacey • 2. Add a fourth Citizen-at-Large Physician to eliminate potential appointment conflicts with existing Citizen-at-Large members • 4.2.2 Encourage the Thurston County Commissioners to expand Citizen-at-Large outreach efforts to fill positions with members from rural county communities. Governance Challenges

  33. 4.3 Observation:Information about the proceedings of the EMS Council is not readily available to the public. Recommendation 4.3.1 TC Medic One staff should post and update the following content on its website in an easily accessible format: EMS Council meeting schedule, a list of EMS Council members, meeting agendas, minutes, TC Medic One Budget, and EMS Council Bylaws. Governance Challenges

  34. 5.1 Observation:TC Medic One does not have a single comprehensive planning document that describes its mission, policies, budget, service delivery model, system performance, future service levels, and strategic initiatives. Planning Challenges

  35. Historic and Forecast Thurston County EMS Call Volumes and Population, 1990 to 2035

  36. Projected ALS Incidents by Age Cohort, 2010-2035

  37. Historic and Forecast Thurston County ALS Incidents, 1990 to 2035

  38. 5.1 Observation:TC Medic One does not have a single comprehensive planning document that describes its mission, policies, budget, service delivery model, system performance, future service levels, and strategic initiatives. Recommendations 5.1.1 TC Medic One should compile its existing plans into a single cohesive document that outlines its current course of action. This product should serve as a baseline for a strategic planning process with all system stakeholders. 5.1.2 The EMS Council should identify an appropriate planning process and forward a recommendation and planning timeline to the Thurston County Commissioners. 5.1.3 TC Medic One should convene a planning process and seek adoption on a preferred alternative prior to running an EMS levy lift. Planning Challenges

  39. Stakeholders should read the report – It will be made available online • TRPC can return to a future meeting to respond to questions • TRPC can present to the County Commissioners • YOU DECIDE What’s Next?

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